The effects of hospital closure on the local utilization of total joint replacement: The queens experience

Since 2000, 31 hospitals have closed in New York State. This has primarily been due to the financial difficulties endured by these institutions, many of which were located in areas inhabited predominantly by patients of lower socioeconomic status. Additionally, recommendations by the NYS Department of Health (Berger Commission) cited excess hospital capacity as a driver for the struggles of the healthcare delivery system in New York, forcing financially stable institutions to close their doors as well. Data has shown that outcomes are improved when complex procedures, such as joint arthroplasty, are performed at high volume hospitals. However, for patients in the outer boroughs of NYC, travel to these specialized centers may be too expensive and physically difficult for poor patients with severe osteoarthritis. Using the SPARCS database, we identified a temporary decrease in utilization of lower extremity total joint replacement in the areas immediately adjacent to closed hospitals. This does not appear to have a lasting effect as illustrated by quick return back to pre-closure trends and further increase when compared with regional trends. This effect is more pronounced in urban areas where public transportation and traffic are more of an issue for patients, making it more difficult to travel with the goal of seeking care elsewhere.